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HomeMy WebLinkAboutYuelys, Nicholas Peter Young,Chairman Q Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O Box 1179 i Southold,NY 11971 Telephone(631)765-1892 Fax(63 1)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., July 10, 2013 the following recommendation was made: Moved by John Stein, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the application of NICHOLAS YUELYS for the as-built 30.5'X 26.2' cement block wall; reinforcement of existing piles damaged by Superstorm Sandy and pre-existing single-family dwelling with wood decks and a 19.3'X 9.5' extension. Located: 56005 County Rd. 48, Southold. SCTM#44-1-19 Inspected by: John Stein Vote of Council: Ayes: All Motion Carried s rl 1 1 mono MONNOW o ` hid MML Nicholas Yuelys 56005 County Road 48,Southold SCTM#44-1-19 7/10/13 t � R r-- •� l y - _ H .. v .. �.' Y�.t wy- '� - �,' ...�� ♦fit _• ,w.ml ♦ T _ - ��+,_��' Iwo Nicholas Yuelys ',A Y• �' ° 56005 County Road 48, +' q* "`��•+r►.r, ,� ._ - "Southold SCTM#44-1-19 NOTE' y 'j�� SUBSURFACE SEWAGE DISPOSAL I S0 SYSTEM DESIGN •(1 BY$, JOSEPH FISCHETTI, P.E. HOBART ROAD SOUTHOLD N.Y. 11971 1611 / ri SUR VEY OF PROPERTY DOVER0TY 5 (631) 765 2954' i AT A SHA2(_/MOQUE L® ,�6'2Q- ;� z TOWN OF S4 UTHOLD �6 %, w SUFFOLK COUNTY, N. Y. 1000-44-01-19 SCALE: 1'-20' f DECEMBER 20, 2011 Fy �•�� IX `��', JAN. 20, 2012 (new septic) MARCH 5 2012 (revisions) MAY 17, 2412 (COASTAL EROSION HAZARD LINEI ' c o MAY 31, 2012 (10' CONTOUR) ,SIVA , ao tA c a TEST HOLE DATA O k 1�iRN �' `� y � M000N°nw �osaENce .� S yy�t1 g fig. P11C OJd -o _ ON SEp 1• 1' DARK BROWN LOAM OL n � N , 10 o. ECEIVE _ j� GX BROWN SILTY SAND SM C�� 1 SAYSE O NEW 8 SEPTIC s � FA 8 2 J U N 2 0 2013 1-1000 GAL PRECAST SEPTIC TANK 4S'L st " 10.8' 2-84x 6' DEEP LEACHING POOLS 3' ABOVE GF � "� WATER WITH 3 SAND (SW) COLLAR tisk _ �': wy Southold Town WATER IN BROWN SILTY SAND SM /-8'0 x 6' DEEP EXPANSION LEACHING POOLDom •_ ���� 0 0 �+ / oar of Trustees EXISTING SEPTIC SYSTEM EXPOSED BY EROSION a �, e r : 6' EP 12' TO BE ROMOVED PER SCDHS. SPECS. c T7 58 Le QM CID TN e' FJ- 11� WATER IN BROWN FINE TO COARSE SAND SW �N C ®ta, 10, ve() O _PROP » _ W o UnuTM 576ro31 20 yETrL L0 . COASTAL EROSION HAZARD LINE FROM COASTAL EROSION HAZARD MAP PHOTO 55-581-83 ELEVA TIONS ARE REFERENCED TO NA VD. i I CL•�' 11.0 I am familiar with the STANDARDS FOR APPROVAL �� AND CONS7RUC77ON OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES 1.3' 4 and will abide b the conditions set forth therein and on the � t". 1 � � Y permit to construct. 4<a ' l The location of wells and cesspools shown hereon are -- CANT ' �-. � ,�'� from field observations and or from data obtained from others. VA <{� ,r 4- ANY ANY ALTERATION OR ADDI77ON TO THIS SURVEY IS A WOLA77ON 3 Loll t€' �'; I OF SECTION 7209 OF THE NEW YORK STATE EDUCA 77ON LAW. ___� ..� " EXCEPT AS PER SECT70N 7209—SUBDIVISION 2. ALL CERTIFICATIONS N. S.* LIC. N0. 496 f{ HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF PECONIC S MORS, P.C. ►q SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR W (631 765-5020 FAX (631) 765-179 HOSE SIGNATURE APPEARS HEREON. AREA= 4, 7SO S'Q.F'T. TO TIE LINES 12.30 TRA E ER STREET qq -/ F c� SOU THOLD, N. Y. 11971 11—'��e' _ I NOTE- y SUBSURFACE SEWAGE DISPOSAL d SYSTEM DESIGN "" BY, JOSEPH FISCHETTI, P.E. � mil- HOBART ROAD ,8 ' SURVEY OF PROPERTY SOUTHOLD N.Y. 11971 ,i (631) 765 2954 AT ARSHAMOMOQ UE OF SO UTHOLD r -5ro �� z TO W� SUFFOLK COUNTY, N. Y. 1000-44-01-19 o SCALE: 1'-20' DECEMBER 20, 2011 EL 4.4 %X mN JAN. 20, 2012 (new sap/ic) co Q, MARCH 5 2012 (revisions) MAY ' EROSION HAZARD LINE) 4E' 3pb + a p MAY 31, 2012 (10' CONTOUR) x f 0' SIM. B0 7. Z TEST HOLE DATA l�lz '� C' MODONDAW GEOSCIENCE 12/20/11 109 OLD Ir '� fR•H �S � �' a co 1' DARK BROWN LOAM OL T EX �• N:.•..,�J_tOtJ� 0 Z9 4t BROWN SILTY SAND SM51 , NEW SEPTIC SYSTEM ( 2 BEDROOMS) v� ,,, 8 z J U N 2 0 2013 1-1000 GAL PRECAST SEPTIC TANK Oil Oil e s't 2 10.8' 2-8'0 x 6' DEEP LEACHING POOL. 3' ABOVE GF WATER WITH 3 SAND (SW) COLLAR zC, � rL t . N y� Southold Town WATER IN BROWN SILTY SAND SM 1-8'0 x 6 DEEP EXPANSION LEACHING POOL. Dom •_ LP v I T+l Ib Board of T ustees EXISTING SEPTIC SYSTEM EXPOSED BY EROSION au' 'o' s- 12' TO BE ROMOVED PER SCDHS. SPECS. ' 6' EP i� �Wl WATER IN BROWN FINE TO COARSE SAND SW mo P - ® � ly9} 142() O PROP M�_ /S o Dnp -- -- - - 576b3�20 "A oG n D �Q(11SS 18 " Cr4 COASTAL EROSION HAZARD LINE FROM COASTAL EROSION HAZARD MAP PHOTO 55-581-83 I IS QS ELEVATIONS ARE REFERENCED TO NA VD. �, 1 am fomiliar with the STANDARDS FOR APPROVAL/ -- --"" � ` AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and will abide by the conditions set forth therein and on the permit to construct. , p' {• The location of wells and cesspools shown hereon are from field observations and or from data obtained from others. VAOAN T , vol ANY AL TERA TION OR ADDITION TO THIS SURVEY IS A VIOLA77ON - OF SECTION 7209 OF THE NEW YORK STATE EDUCA77ON LAW. - EXCEPT AS PER SEC77ON •7209—SUBOIVISION 2. ALL CERTIFICA77ONS -J l.�lye� N.Y.S. LIC. N0. 496 '# HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF E� SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR ;I pECON/C S YORS, P.C. ( WHOSE SIGNATURE APPEARS HEREON. (631) 765-5020 FAX (631) 765-179 P.O. BOX 909 AREA= 4, 730 SQ.FT. TO TIE LINES 1230TRA vEL R S BEET 11-23-4 pgpPF041r James F King,President p� �' P.O Box 1179 Bob Ghosio,Jr,Vice-President �� � Southold,NY 11971 Dave Bergen Telephone(631 765-1892 John Bredemeyer Fax(631)765-6641 Michael J Domino 'F Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: J 0 L' 1-3 Patricia C. Moore, Esq. on behalf of NICHOLAS YUELYS requests a Wetland Permit and a Coastal Erosion Permit for the as-built 30.5'x26.2' cement block wall; reinforcement of existing damaged piles under dwelling; and for the existing single family 30.5'x26.2' dwelling with a 19.3'x9.5' landward extension and existing wood decks. Located: 56005 County Road 48, Southold. SCTM# 44-1- 19 Type of area to be impacted: Saltwater Wetland Freshwater Wetland ZSound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: ,✓Chapt.275 L-"'Chapt. 111 other Type of Application: Wetland '6`oastal Erosion _Amendment —Administrative—Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: King B. Ghosio G-'/-D. Bergen, Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: i Town of Southold _ Town of Southold A - 2488 Suffolk County, NY A 2 �J Suffolk County, IVY The People of the State of New York vs. The People of the State of New York vs. F LAST NAM (DEFENDANT) LAST NAME(DEFENDANT) FIRST NAME MIDDLE INITIAL NAME MIDDLE INITIAL ji�ji:- � � .1 �.' `:Ni 1-'� t'-cY 1�! t..1 i eft v't ,•-_`/ STREET ADDRESS STREET AqDRESS APT NO APT NO r CN STAiE_ ZIP CIN STATE ZIP I < iL3r'.� r•t .0-5, 5 a LICENSE OR REGISTRATION NUMBER r( LICENSE OR REGISTRATION NUMBER TY I STATE TYPE OF LICENSE DATE EXPIRES SEXt.ATE OF BIRTH OPERATOR STATE PE OF LICENSE DATE EXPIRES SEX DATE OF BIRTH OPERATOR MONTH DAY YEAR OWNS VEHICLE 9 DAY Y � ❑YES ❑NOof ,y A 1 1 ♦ : _.-, a� , f OYES ❑NO THE OPERATOR OR REGISTERED OWNER THE OPERATOR OR REGISTERED OWNER OF VEHICLE DESCRIBED BELOW OF VEHICLE DESCRIBED BELOW P PLATE NO DATE EXPIRES LATE NO DATE EXPIRES I` STATE PLATE TYPE STATE PLATE TYPE❑N Y ❑N J ❑N Y O N J ❑ ❑PASS ❑COMM ❑ ❑NY ❑NJ ❑NY ❑NJ El ❑PASS ❑COMM ❑ VEHICLE MAKE 13 DODGE i VEHICLE MAKE 11 DODGE _ ❑ BUICK ❑ CHEV ❑ CADILLAC ❑ PONTIAC Q BUICK ❑ CHEV ❑ CADILLAC ❑ PONTIAC ❑ FORD ❑ OLDS ❑ PLYM ❑ FORD ❑ OLDS ❑ PLYM ❑ TOYOTA ❑ VOLKS ❑ p ❑ TOYOTA ❑ VOLKS ❑ BODY ❑ 2 DR ❑ 4 DR ❑ BUS ❑ MCY ❑ SW I` BODY ❑ 20R ❑ 4 DR ❑ BUS ❑ MCY ❑ SW TYPE ❑ TRUCK ❑ TRAILER ❑ VAN ❑ !NII TYPE ❑ TRUCK ❑ TRAILER ❑ VAN ❑ VIN NUMBER VIN NUMBER - THE PERSON DESCRIBED ABOVE IS CHARGED AS FOLLOWS THE PERSON DESCRIBED ABOVE IS CHARGED AS FOLLOWS �� PLACE OF OCCURRENCE PCT PLACE OF OCCURRENCE _ PCT � n I 1� > �'`A to �-I t' DATE OF OFFENSE j AM TIMET PM CITY TOWN,VILLAGE OR HAMLET SUFFOLK COUNTY NY I DATE OF OFFENSE AM TIME PM CIN,TOWN VILLAGE,OR HAMLET SUFFOLK COUNTY NY Eg IN VIOLATION OF SECTION SUED OF THE❑VEHICLE AND TRAFFIC LAW OF THE STATE OF NEW YORK IN VIOLATION OF SECTION SUBD OF THE❑VEHICLE AND TRAFFIC LAW OF THE STATE OF NEW YORK -0-OTHER(SPECIFY) El O S ❑COM ❑BUS ❑— I :❑OTHER(SPECIFY) - ❑0 S ❑Com ❑BUS ❑HAZ DEF VEH MATS l- {(/ �.- DEF VEH MAT ❑ SPEEDING OTHER OFFENSE ❑ SPEEDING OTHER OFFENSE ` MPH IN A MPH ZONE �* •(• " ;,(- Y MISDEMEANOR 11 MPH IN A MPH ZONE MISDEMEANOR El FACTUAL PART(NOT FOR TVB) - f FACTUAL PART(NOT FOR TVB) 3 THE ABOVE NAMED DEFENDANT DID ON THE STATED DATE,TIME AND PLACE -7. ( THE ABOVE NAMED DEFENDANT DID ON THE STATED DATE,TIME AND PLACE t•s'� .+ - C�z.'^ -!''� *, F N 1 `•s- i' ^`'#` +'-1 _-ate� 'f �� Ao The Fore � � y , The Foregoing is based on ersonal knowledge)and/or formation-&-belre the sonrc ben-4ne.ettachetlsv7&r�osrt going is based on(personal knowledge)apd/ounforMaab�n&b�,e.*kef),the source bein the a-acbed.sworwde osRion s of 9 9 ; (P 9) (+n R: 9 P .R(s)of , .. �P.�,.=.tF- ,."---P () 4�1 JDUt dated Q'., -1._5:-1� f - dated B a� f PARKING SCHEDULED FINE$ CONTACT COURT❑ PARKING SCHEDULED FINE$ CONTACT COURT❑ THE PERSON DESCRIBED ABOVE IS SUMMONED TO APPEAR AT THE PERSON DESCRIBED ABOVE IS SUMMONED TO APPEAR AT SOUTHOLD TOWN JUSTICE COURT,53095 ROUTE 25,SOUTHOLD,NY 11971 I SOUTHOLD TOWN JUSTICE COURT,53095 ROUTE 25,SOUTHOLD,NY 11971 i DATE OF APPEARANCE(NOT FOR NB) DATE OF APPEARANCE(NOT FOR NB) IIi ON 1 QAt' ):^�c i`` N I ON •Y t i .:-� AT 1'�w_- AnNLM '( J AT 1 AWT, I v ( FALSE STATEMENTS HEREINARE PUNISHASLEAS A CLASS A MISDEMEANOR PURSUANTTO SECTION 21045 OFTHE P L N Y S FALSESTATEMENTS HEREIN ARE PUNISHASLEAS ACLASS A MISDEMEANOR PURSUANTTO SECTION 11041 OFTHE P LN YS DATE COMPLAINANT DATE r, _ COMPLAINANT j - tti 4 !A1 - BADGE# - Nf!`l __ BADGE# 13 Southoid town a f Trustee - V M _ � v " x ` YUELYS 56005 CTY ROAD 48, SOUTHOLD SCTM: 1000-44-1-19 '4 f • YUELYS 56005 CTY ROAD 48, SOUTHOLD SCTM: 1000-44-1-19 o 41. T-4. f. JF '4„)`. tp 40 J.. YUELYS 56005 CTY ROAD 48, SOUTHOLD r >_. 111 • s 5 T Y sit YUELYS 56005 CTY ROAD 48, SOUTHOLD + SCTM: 1000-44-1-19 -- +- k� No YUELYS op ,. 56005 CTY ROAD 48, SOUTHOLD y _. .,,,, SCTM: 1000-44-1-19 f 1 i 1.1 v � r c t - a 5 f qf --�Y � -•i ._ ` —4 _. _. /~Pews... . r._t. � 1 YUELYS �++` _ .:• -° ` '�"` ` '` + ",ate _ 56005 CTY ROAD 48, SOUTHOLD L —, .r � , - — SCTM: 1000-44-1-19 ,a. ;--A40'' Je► . `' s .r._ ir=. ..mss i r' r F Alp"J ,.. .�, — AVtr `.. ''ma ::- ,fit A�. w l� d z _ Opp r a fes+ ' S # ..F ry + Wl, Iw ip AIV t-4 *'� 9► w- $Y m e e i AL R �2 40 lop F 3. - :.. - _ :�._. i:� atiF �=, _W. fir, � �� .. � _• -_..+�_ "•' r 3 �d` r�4 �4E£ e � � xr ,r /6Op W ,i k'xH v Y W aro- ,�y✓ �0 `�d3k• �� s� e f Wy3`�'� 4W k 3z Awe, <, W t q � x � ( Q � ���W �t l -� .�» ,;,"0," � 'dam=- �•.r ,v, �� § u� mar+ W,• 4 -ys' x: z r � v � as W g �n 'a s: s" t �• r 9 ' � e i I h - - WUNnLF suFF �. _ N D a P gain I � N I z Q 0 FOR POL NO I 015-01 St I I t �71 H G 1 as ® I p / r• $ 1BA I LWa IS or suFFOFolx COIL—FSOFFQM ` � a a , •j,, . . ," Y MATG1----ZZ____—11NE 5 r' 9 S. T SEE SEG NO 04 4 T � Q j Nm ^ B e 3 aC E E^�+•^'�- �^ ^ '^ — -- �^'"' --'°'-- °a°"' --n-- NOTICE COUNTYOFSUFFOLK © K or SWa1010 SECTION NO E Gar Real Property Tax Service Agency v mxayau°.RN.maa.xvnm5 M 44 m P xcTxo 1000 - ��i -p, �y�,M. '^ `� _� - a..r •,4vu r—i;'.. _. ��� `=-�-� --.—_�_..-r�sa.__;_ _.__.Ixx I __ -__.._ � 1� - t. ,.r ,-_t _ t _ _ . _n^c. ,a I'- _ _ t _, SUBSURFACE SEWAGE DISPOSAL ,j SYSTEM DESIGN BY, JOSEPH FISCHETTI, P.E. k, SURVEY OF PROPERTY HOBART ROA ��� 50� , ►J Ulf. 6r.Ci 4 SOUTHOLD N.Y. 11971 A T ARCH'A MOMOQ U"Ej (631) 765 2954 / 1 �7 t9 161 �[ ISO TOWN OF SO UTHOLD �65�6 , PLS SUFFOLK COUNTY, 1000-44-01-19 SCALE: 1'-20' o % 'I- DECEMBER 20, 2011 Ej� 4.4' %�X M") JAN. 20, 2012 (new septic) o MARCH 5 2012 (revisions) aL MAY 17, 2012 (COASTAL EROSION HAZARD LINE) �` I MAY 31, 2012 (10' CONTOUR) 0 Cl) TEST HOLE DATA FR Nom' S D MoDONDALD GEOSCIENCE 12/20/11 v 2 �l PL J�TIG Vv V Fnn DARK BROWN LOAM OL T �� Q 1• T "A JUN 2 0 2013 BROWN SILTY SAND SM O 4 1 NSE NEW SEPTIC SYSTEM z FR' v o Southold Town ( 2 BEDROOMS) , '1 •-B y -z sT�'. ' _ of Trustees /-1000 GAL PRECAST SEPTIC TANK 4,0'` e. 5 m N 1o.e' 2-8'0 x 6' DEEP LEACHING POOLS 3' ABOVE GF m I WATER WITH 3 SAND (SW) COL LAR WATER IN BROWN SILTY SAND SM /-8'0 x 6' DEEP EXPANSION LEACHING POOL Nom ; '�'� Lp s O o W� EXISTING SEPTIC SYSTEM EXPOSED BY EROSION�N / 6' E 12' TO BE ROMOVED PER SCDHS. SPECS, o - ! u -n-1 ' .N z� p 11 TccTN e' FJ- 11 WATER IN BROWN FINE TO COARSE SAND SW m o� is [ 4 ® Ev- X1.9 H2O O Z Ljiyl PROP �",_ o OLE Un 576b3�2a r, SEL tNE� 18' COASTAL EROSION HAZARD LINE FROM COASTAL EROSION HAZARD MAP PHOTO 55-581-83 ELEVA TIONS ARE REFERENCED TO NA VD. u"�L, ! am familiar with the STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES , '` O�j ` '-'° � . 11.3 and will abide by the conditions set forth therein and-on the 1permit to construct. ' The location of wells and cesspools shown hereon are 1' from field observations and or from data obtained from others. r - 1 ��'I�; ANY ALTERATION OR ADDITION TO THIS SURVEY IS VIOLA770N �Ci3/ �f OF SECTION 7209 OF THE NEW YORK STATE EDUCA77ON LAW. r-` N.Y.S. LIC. NO. 49f I,I EXCEPT AS PER SECTION •7209-SUBDIVISION 2. ALL CERTIFICATIONS 1 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF PECONI C 0 YOBS, P.C. fj SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR (631) 765-5020 FAX (631) 765-175 WHOSE SIGNATURE APPEARS HEREON, P.O. BOX 909 AREA= 4.,, 75'0 SQ.FT. TO TIE LINES 1230 TRA VELER STREET 11-233 SOU THOLD, N. Y• 11971 1 Addendum 1. footings& cement block replacement; replace existing foundation wall which washed away during SANDY , /too 5e : 50 5 ' x -:4 'L Addendum 1. footings & cement block replacement; replace existing foundation wall which washed away during SANDY , r / 9 3 J0 Addendum 1. footings& cement block replacement; replace existing foundation wall which washed away during SANDY , t Addendum 1. footings& cement block replacement; replace existing foundation wall which washed away during SANDY �oC�S5c 2- e c,�cl a o70 I I - James F.King,President QUTy Town Hall Annex I j Bob Ghosio,Jr.,Vice-President 54375 Main RoadP.O.Box 1179 Dave Bergen t Southold,New York 11971-0959 John Bredemeyer G �' Telephone(631)765-1892 Michael J.Domino 'Q Fax(631)765-6641 f' NV,�� i BOARD OF TOWN TRUSTEES ►. TOWN OF SOUTHOLD a Office Use Only i Coastal Erosion Permit Application Wetland Permit Application Administrative Permit _Amendment/Transfer/Extension _Received Application: _Received Fee:$ _Completed Application D E �Q fl V E i _Incomplete I _SEQRA Classification: Type IL Type 11 Unlisted JUN 2 0 2013 ID _Coordination:(date sent) . LWRP Consistency Assessment Form ! _CAC Referral Sent: Date of Inspection: Southold Town ; ^_Receipt of CAC Report: Board of Trustees _Lead Agency Determination: _ Technical Review: _Public Hearing Held: `Resolution: s Name of Applicant Nicholas Yuel Y C Mailing Address 3240 Tibbett Avenue Bronx NY Phone Number:( ) Suffolk County Tax Map Number: 1000- 44-1-19 Property Location: 56005 County Road 48 Southold (provide LILCO Pole#,distance to cross streets,and location) AGENT: Patricia C. Moore (If applicable) Address: 51020 Main Road, Southold, NY 11971 Phone: 631-765-4330 Board of Trustees Application i i f GENERAL DATA Land Area(in square feet): 4,730 sf i r-40 Area Zoning: 1. Previous use of property: existing dwelling Intended use of property: foundation repairs to existing dwelling i Covenants and Restrictions onlfl ro ert Yes X No p p If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? X Yes No i If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes X No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes x No i Does the structure(s) on property have a valid Certificate of Occupancy? X Yes No I Prior permits/approvals for site improvements: Agency Date Health Dept 9/10/12 i Trustees-sanitary replacement 6/20/13 i DEC 6/27/13 (' No prior permits/approvals for site improvements. Has any permittapproval ever been revoked or suspended by a governmental agency? x No Yes If yes,provide explanation: Project Description(use attachments if necessary): repairs to existing foundation damaged by SANDY- See 1 in Addendum Board of Trustees Application a 1WETLANDITRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: existing house foundation damaged and immediate action to stabalize structure completed Area of wetlands on lot: 1.500 sf square feet Percent coverage of lot: 25% �% Closest distance between nearest existing structure and upland edge of wetlands: 0 feet Closest distance between nearest proposed structure and upland edge of wetlands: 0 feet Does the project involve excavation or filling? I No X Yes If yes,how much material will be excavated? cubic yards I How much material will be filled? n/a cubic yards Depth of which material will be removed or deposited: n/a feet Proposed slope throughout the area of operations: LlSound Manner in which material will be removed or deposited: by hand and small equipment Statement of the effect,if any,on the wetlands and tidal waters of the town that may result by reason of such proposed operations(use attachments if appropriate): none Addendum 1. footings& cement block replacement; replace existing foundation wall which washed away during SANDY Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes ofproposed activity: D/ / sf ' 'C�Gz���'err ci elc a e eeZ412ed lig cSAI)ICI IV f Are wetlands present within 100 feet of the proposed activity? No K Yes Does the project involve excavation or-filling? No X Yeso{c�tc/s If Yes,how much material will be excavated? dV14 (cubic yards) How much material will be filled? A//.A (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) ��`�/Yl �Ctl�'Ia G'� CGUc�!S�� f��1 c�P�'rlJ7 rG2 i�rlc eu I�C�,OCf �Vy CL`r r,��r'/�,�P� fig'!l✓Ln�,�,ia/z �./ 7� ,�I Y��tit-- Jas� v� �fvc.►�fvre Board of Trustees Application County of Suffolk State of New York NICHOLAS YUELYS BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. r Sworn to before me this S day of 2013 _ j otaNi*AAh1ANV.,V1DA Notary Public.Sta4e o,Ndw'a!k, No.01V182406?4, Oualf W in Bronx¢oanty. bion Moi►2.2615 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) Nicholas Yuelys as owners of premises 56005 County Road 48, Southold,New York, (scthn: 1000-44-1-19) residing at 3240 Tibbett Ave.,Bronx,New York do hereby authorize my attorney, Patricia C. Moore,to apply for permit(s) and appear before the Southold Board of Town Trustees on our behalf. O er's signature) MARIA V.VIDAL s I • o Notary Public,State of New York ' No.01 VI6240574 ' ®ualNied in Bronx County f Wy 2,2015 ! APPLICANT TRANSACTIONAL DISCLOSURE FORM (FOR SUBMISSION BY OWNER and OWNER'S AGENT) The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of Town officers and employees The purpose of this form is to provide information,which can alert the Town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same, YOUR NAME: YUELYS,NICHOLAS MOORE,PATRICIA (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company. If so,indicate the other person or company name.) NATURE OF APPLICATION.(Check all that apply.) Tax Grievance Variance Special Exception If"Other", name the activity: Change of Zone Approval of Plat Exemption from Plat or Official Map Other Trustees X Do you personally,(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the Town officer or employee has even a partial ownership of(or employment by) a corporation in which the Town officer or employee owns more than 5% of the shares. YES NO_X Complete the balance of this form and date and sign below where indicated. Name of person employed by the Town of Southold. Title or position of that person: Describe that relationship between yourself(the applicant) and the Town officer or employee. Either check the appropriate line A through D(below)and/or describe the relationship in the space provided. The Town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant(when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this� day of 2V Signature: Nichola a ys cia C. ore MARIA V.V10'AL NftY Pubft.Slate of NdW Ybrk No.01VI6240514 ®tlali 80 In 8rorix county ..,;�initdtltlt��i re�AR�y 2:�bi� G17.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION To be completed by A 3plicant or Project Sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME Nicholas Yuelys 3. PROJECT LOCATION. Municipality County Road 48 County 4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) 56005 County Road 48 44-1-19 5. PROPOSED ACTION IS: F] New [-] Expansion ❑X Modification/alteration 6 DESCRIBE PROJECT BRIEFLY: repair and replacement of existing foundation damaged by SANDY 7 AMOUNT OF LAND AFFECTED: 4 730 sf Initially 4,730 sf acres Ultimately acres 8 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Q Yes E] No If No,describe briefly 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ElResidential ❑ Industrial Commercial Agriculture Park/ForesVOpen Space Other Describe. 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,STATE OR LOCAL)? f1YesX❑No If Yes,list agency(s)name and permittapprovals: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes 0 No If Yes,list agency(s)name and permit/approvals: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? E]Yes 0 No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name. cla C. oore Date: June 18,2013 Signature: i If the action is in the Coastal Area, and you are a state agency, complete the � Coastal Assessment Form before proceeding with this assessment OVER 1 PART II - IMPACT ASSESSMENT o be completed by Lead Agency) r3l ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. es E] No CTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative tion may be superseded by another involved agency. es E] No ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) xisting air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, otential for erosion,drainage or flooding problems? Explain briefly, C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly C3 Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change to use or intensity of use of land or other natural resources?Explain briefly. C5. Growth,subsequent development,or related activities likely to be induced by the proposed actions Explain briefly: C6 Longterm,short term,cumulative,or other effects not Identified in C1-05? Explain briefly: C7 Other impacts(including changes in use of either quantity or type of energy)? Explain briefly: D WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? nYes n No If Yes,explain briefly E IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? F]Yes R No If Yes,explain briefly- PART rieflyPART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring;(c)duration;(d)irreversibility;(e) geographic scope;and(f)magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes,the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA rlCheck this box if you have Identified one or more potentially large or significant adverse impacts which MAY occur.Then proceed directly to the FULL EAF and/or prepare a positive declaration. Ej Check this box if you have determined,based on the information and analysis above and anysupporting documentation,that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide,on attachments as necessary,the reasons supporting this determination Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS ' 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list,policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town) 3. If any question in Section C on this form is answered yes or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non su porting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. !_ A copy of the LWRP is available in the following places: online at the Town of Southold's i. website(southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 44-1-19 PROJECT NAME foundation repair/replacement The Application pp n atYon has been submitted to(check appropriate response): Town)Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees ❑ 1. Category of Town of Southold agency action(check appropriate"response): (a) Action undertaken directly by Town agency(e.g.capital ❑ construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: Nature and extent of action: repair existing foundation under house, replace footings and cement wall damaged by Location of action: 56005 County Road 48 Site acreage: 4,730 sf Present land u_se: existing dwelling Present zoning classification: r-40 'I 2. If an application for the proposed action has been filed with the Town of Southold agency, the following C information shall be provided: (a) Name of applicant: Nicholas Yuelys i (b) Mailing address: 3240 Tibbett Avenue Bronx NY j, (c) Telephone number:Area Code O (d) Application number,if any: I i Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑. No 0 If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, Preserves open space,makes efficient use of infrastructure,makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑X Yes 0 No ❑ Not Applicable existing house preexisting nonconforming-foundation damage during SANDY storm-imme is a ac ion require Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No 0 Not Applicable i• i Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria { i ❑ Yes ❑ No x❑ Not Applicable ` x• i I Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages S through 16 for evaluation criteria I ❑X Yes ❑ No ❑ Not Applicable I , sting house damaged by storm-fo nidation repairs,required to protect existing structurre . � f 1 Attach additional sheets if necessary Policy S. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No 0 Not Applicable ' 1 Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III--Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ i Yes No Not Applicable , Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies j Pages 32 through 34 for evaluation criteria. ❑ Yes ❑No U Not Applicable I i f' itr I' l Attach additional sheets if necessary I Policy S. Minimize environmental degradation in Town of Southold from solid waste and hazardous j substances and wastes. See LWRP Section III--Policies; Pages 34 through 38 for evaluation criteria. i i ❑ Yes ❑ No 0 Not Applicable i I. PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public + resources of the Town of Southold. See LWRP Section III—Policies;Pages 38 through 46 for evaluation ! criteria. ❑ Ye❑ No® Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES r Policy 14. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in s suitable locations. See LWRP Section III—Policies;Pages 47 through 56 for evaluation criteria. i Yes ❑ No X❑ Not Applicable Attach additional sheets if necessary r Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No 0 Not Applicable i t i Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III —Policies; Pages i 62 through 65 for evaluation criteria. i ❑ Yes ❑ No 0 Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III--Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No 0 Not Applicable PREPARED l3y Patricia C. Moore TITLE AGENT DATE 6/18/13 Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT g FORM PROPERTY LOCATION: S.C.T.M.#: ! �Ol� THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER GRADING,DFRair GE AND EROSION CONTROL PLAN _13TsErcr SectionBlock —C! CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? {include Total Area of all Parcels located within L/ •� 1 Will this Project Retain All Storm Water Run-Off the Scope of Work for Proposed Construction) `3a Sr Generated by a Two(2")Inch Rainfall on Site? (S.F.IAcres) (This Item will include all run-off created by site b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed 7��+7 s Site Improvements and the permanent creation of construction activity? impervious surfaces.) (S.F.i Acres) ' PROVIDE BRIEF PROJECT DESCRIPTION (Provide Additional Pages)Needed) 2 Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size&Location?This Item shall include all Proposed Grade Changes and X `y Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion YiCL�LC 4 and sediment control practices that will be used to control site erosion and storm water discharges. This i '5-tVT?''7 C GL YYlGc Q f item must be maintained throughout the Entire ! Construction Period. 4 Will this Project Require any Land Filling,Grading or /tC1L � J j T L` Excavation where there is a change to the Natural T r-' Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? rj Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand ❑ X (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction X General DEC SWPPP Requirements: or Within One Hundred(100')feet of a Wetland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; Including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to including Construction activities involving soli disturbances of less than one(1)acre where X One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit is required for storm water discharges. — (SWPPP's Shall meet the Minimum Requirements of the SPDES General Penult $ Will Driveways,Parking Areas or other Impervious for Storm Water Discharges from Construction activity-Permit No.GP-040-001.) Surfaces be Sloped to Direct Storm-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of the Not.The NOI shall be into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder, compliance with the terms and conditions of this permit.In addition,the SWPPP shall Area?(7rris Item will NOT Include the Installation ar Driveway Identify potential sources of pollution which may reasonably be expected to affect the y Aprons.) quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the poskconstruction storm water management practice In a Box and the construction site disturbance is between 5,000 S.F.&1 Acre in area, component shall be prepared by a qualified Design Professional Licensed in New York a Storm Water,Grading,Drainage&Erosion Control Plan Is Required by the Town of t that Is knowledgeable in the principles and practices of Storm Water Management Southold and Must be Submitted for Review Prior to issuance of Any Building Permit. (NOTE A Check Mark(r)and/or Answer for each Question is Required for a Complete Application) SPATE OF NEW YORK, COUNTY OF .... . . ...........SS That I,......CG �: .u....caifinlng ��Q ' ••..,••,•being drily sworn,deposes and says that he/she is the applicant for Permit, (Namf iDocument) And that he/she is the .............................:..... ... (Owner.Conlra ,Agenl,Corporate O(5oer,etc.)..•...•.........•••....................................•....... Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his knowledge and belief;and that the-work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; ....... ...`...........2C3t"�....day of.. .. �.• • v•goals taty Public: ................... �t.fi�i.l7e, :9€ of l °`�................. . 4�lint3f foto. f e ................................................... a 1 t (Signature of Applicant) M - 06110 �u iTik :;g. C0rnfaet55i,,)R Eypires januXY 31.1 i i Nam I own of Southold gErosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: s.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A O! STORM-WATER GRADING,DRAIP[AGE AND EROSION CONTROL PLAN -bTs-6 c Section -1115Z - - off— CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE O KNEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCT ION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? (Include Total Area of all Parcels located withinWill this Project Retain All Storm-Water Run-Off the Scope of Work for Proposed Construction) r -730 Generated by a Two(2")Inch Rainfall on Site? (S.F.r Acres) (This item will include all run-off created by site b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or ruction activGround Disturbance for the proposed '�� Site Improvements and the permanent creation of constity? impervious surfaces.) IS F./acres) PROVIDE BRIEF PROJECT DESCRIP'ITON (Provide Additional Pages es Needed 2 Does the Site Plan and/or Survey Show All Proposed i Drainage Structures Indicating Size&Location?This Item shall include all Proposed Grade Changes and X Slopes Controlling Surface Water Flow. newo3 Does the Site Plan and/or Survey describe the erosion �C��tLC and sediment control practices that will be used to control site erosion and storm water discharges. This 15- b -k" C71a Mct Q e item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Land Filling,Grading or T_) 0 Excavation where there is a change to the Natural r�ra Existing Grade Involving more than 200 Cubic Yards Ivnt"u t- /Q 5� „ C of Material within any Parcel? tj Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand K (5,000 S.F.)Square Feet of Ground Surface? 6 is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Requirements: or within One Hundred(100')feet of a Wetland or Submission of a SWPPP Is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; Including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes are part of o larger common plan that will ultimately disturb one more acres land; which Exceed Fifteen(15)feet of Vertical Including Construction activities involving soil disturbances of lesss a than one(1)acre where Rise to X the DEC has determined that a SPDES permit is required for storm water discharges. One Hundred(100')of Horizontal Distance? — (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious y� for Storm Water Discharges from Construction activity-Permit No.G13-0-10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of the NOI.The Not shall be into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road ShoulderEl compliance with the terms and conditions of this permit In addition,the SWPPP shall Alga?(This item will NOT Include the Installation of DrivewaydS Identify potential sources of pollution which may reasonably be expected to affect the Aprons.) quality of storm water discharges. , NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the post construction storm water management practice in a Box and the constructlon,site disturbance is between 5,000 S.F.&1 Acre in area, component shall be prepared by a qualified Design Professional Licensed in New York a Store Water,Grading,Drainage&Erosion Control Plan is Required by the Town of that is knowledgeable in the principles and practices of Storm Water ManagemenL Southold and Must be Submitted for Review Prior to Issuance of Any Building ParmlL (NOTE: A(heck Mark(.1')and/or Answer for each Question is Required for a Complete Application) STATE OF NEW YORK, COUNTY OF......%`` .�.1 ............SS That I,.......G.{r. fr. .u.... (Name of indivldua signing Document) .. being drily sworn,deposes and says that he/she is the applicant for Permit, And that he/she is the .............................:+. .. ... (Owner.Contra• .Agent,Corpoiate Officer,etc)...•. .. ....•.••... ...... ..... ........ . Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his knowledge and belief-,and that the-work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; - day of............ . ........ZG .... x.90 ........ ..�. Erul,14L 'I vNotoryPublic: ............... 3s"V4uliisr ...o York ...... ............. y na g IF (Signature of Applicant) FORM - 06/10 CQh6"f MISSic,n Eypirar,Jan u' Y S'1, t9 PATRICIA C. MOORE Attorney at Law 51020 Main Road Southold,New York 11971 Tel:(631)765-4330 Fax..(631)765-4643 July 15, 2013 via email only JUL 1 5 2013 Board of Trustees Town of Southold Southold Town P.O. Box 1179 rus ee Southold, NY 11971 Re: Nicholas Yuelys Premises:56005 County Road, 48, Southold SCTM: 1000-44-1-19 Dear President King and members : Please be advised that we wish to postpone the above application so that we may coordinate with engineer, Joseph Fischetti in order to obtain a permit for the final design. Thank you. Very truly yours, / S / Patricia C. Moore PCM/bp t PATRICIA C. MOORE, ATTORNEY ®T-I.AW ]�(')��') 51020 Main Road J �UU�Y® Southold, IVY 11971 LETTER (631) 765-4330 email: pcmoore@mooreattys.com D E C E � V E ate Z•� Toubject S _;� JUN 2 6 201 I _ �.I� - I - I Southold Town Board of Trustees . . - . . . . . . . .... . . . . - - . . . . ... . . .... -. -. . . . .. . - . . . .. -.. . . ... . . .. .. . .. - -- - - - - -- -. .-- .. . .... . . ... . ... . ... .. .. .--..--.. . . .. . . .. ..... . . . SIGNED ElPlease reply ElNo reply necessary l t f m1 �• r1 James F.King,President ��0�SODTyO Town Hall Annex j i Bob Ghosio,Jr.,Vice-President 54375 Main RoadP.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer G Telephone(631)765-1892 Michael J.Dominof^. � Y Fax(631)765-6641 OWN ( ' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD I ; Office Use Only Coastal Erosion Permit Application ; XWetland Permit Application _Administrative Permit j. _Amendment/Trans er Ext ion Received Application: b 3 �eived Fee:$ i mpleted Application &j-jj)j.j3 _Incomplete _SEQRA Classification: Type I Type 11Unlisted I 1 �oordination:(date sent) JUN 2 0 2013 WRP Consistency Asse smen Form �2 /CAC Referral Sent: ate of Inspection: ; _Receipt of CAC Report: Southold Town I j Board of Tri^t�°s Lead Agency Determination: Puechnical Review: Public Hearing Held: Resolution: Name of Applicant Nicholas Yuelys Mailing Address 3240 Tibbett Avenue Bronx NY Phone Number:( ) I Suffolk County Tax Map Number: 1000- 44-1-19 Property Location: 56005 County Road 48 Southold (provide LILCO Pole#,distance to cross streets,and location) AGENT: Patricia C. Moore (If applicable) Address: 51020 Main Road, Southold, NY 11971 Phone: 631-765-4330 Di i Board of Trustees Application I GENERAL DATA Land Area(in square feet): 4,730 sf r-40 Area Zoning: ;. Previous use of property: existing dwelling j Intended use of property: foundation repairs to existing dwelling Covenants and Restrictions on property? Yes X No '!{ If"Yes",please provide a copy. ' Will this project require a Building Permit as per Town Code? X Yes No If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes X No If"Yes",please provide copy of decision. i Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes X No Does the structure(s)on property have a valid Certificate of Occupancy? X Yes No Prior permits/approvals for site improvements: Agency Date ` Health Dept 9/10/12 i Trustees-sanitary replacement 6/20/13 i DEC 6/27/13 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? x No Yes If yes,provide explanation: Project Description(use attachments if necessary): repairs to existing foundation damaged by SANDY- See 1 in Addendum 1 YUELYS 56005 CTY ROAD 48, SOUTHOLD SCTM: 1000-44-1-19 PROJECT DESCRIPTION: AM 6c&.0 Rcep 30.5 x 26.2 feet cement block wall; reinforcement of existing piles damaged by Super Storm Sandy and pre-existing single family tdwelling. C 3 0,S l- x Zj,,Z-F tiV`A4, W Wo\ 64-c S cwt (q. 3.:t A 9-5S 1 tK4enS Ca�� Board of Trustees Application ; s WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: existing house foundation damaged and immediate action to stabalize structure completed Area of wetlands on lot: 1,500 sf square feet Percent coverage of lot: 25% % ` Closest distance between nearest existing structure and upland edge of wetlands: 0 feet Closest distance between nearest proposed structure and upland edge of wetlands: 0 feet } i Does the project involve excavation or filling? f I No X Yes If yes,how much material will be excavated? cubic yards How much material will be filled? n/a cubic yards ` Depth of which material will be removed or deposited: n/a feet it Proposed slope throughout the area of operations: LlSound Manner in which material will be removed or deposited: f. by hand and small equipment Statement of the effect,if any,on the wetlands and tidal waters of the town that may result by reason of such proposed operations(use attachments if appropriate): none / Hoard of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: ,4'e' Are wetlands present within 100 feet of the proposed activity? No K Yes Does the project involve excavation or filling? No k Yes Hokin ys If Yes,how much material will be excavated? AIM (cubic yards) How much material will be filled? N/A (cubic yards) Manner in which material will be removed or deposited:: c7<nall aaid yrs r<"d Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) /7C 5-/7 1 arnay- r o� r�S <��,r-/�,rf�,Lem �n��✓tndcQ /411 riVAPC4tt- f QS c ivne 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I -PROJECT INFORMATION To be completed b T2- licant or Project S onsor1. APPLICANT/SPONSOR PROJECT NAME Nicholas Yuelys 3 PROJECT LOCATION. Municipality County Road 48 County 4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc,or provide map) 56005 County Road 48 44-1-19 5 PROPOSED ACTION IS: Ej New E] Expansion ❑X Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: repair and replacement of existing foundation damaged by SANDY 7 AMOUNT OF LAND AFFECTED: 4 730 sf Initially 4,730 sf acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? FX]Yes n No If No,describe briefly 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? FX Residential 0 Industrial Commercial Agriculture 1:1 Park/Forest/Open Space Other Describe 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,STATE OR LOCAL)? YesX❑No If Yes,list agency(s)name and permit/approvals 11 DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes 0 No If Yes,list agency(s)name and permit/approvals: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? Yes r-,, No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicanUsponsor name Cla C. oore Date: June 18, 2013 Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 YUELYS 56005 CTY ROAD 48, SOUTHOLD SCTM: 1000-44-1-19 PROJECT DESCRIPTION: &a .5 x 26.2 feet cement block wall; reinforcement of existing piles damaged by Super Storm Sandy and pre-existing single family dwelling.('00,, X z Co'2-! wc�k PART II- IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617 4? If yes,coordinate the review process and use the FULL EAF. Yes No B WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes ffNo C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly- C4. rieflyC4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly C5 Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly C6 Longterm,short term,cumulative,or other effects not identified in C1-05? Explain briefly: C7 Other impacts(including changes in use of either quantity or type of energy)? Explain briefly. D WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? nYes [ffNo If Yes,explain briefly E IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? 0 Yes P-j"No If Yes,explain briefly: PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring;(c)duration;(d)irreversibility;(e) geographic scope;and(f)magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes,the determination ofsignificance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur Then proceed directly to the FUL EAF and/or prepare a positive declaration. Check this boxifyou have determined,based on the information and analysis above and anysupporting documentation,that the proposed actionWILL F -h NOT result in any significant adverse environmental impacts AND provide,on attachments as necessary,the reasons supporting this determination ooign eF r/2a57-,—<, c_ / v 2. a13 Name of Lead Agency Date CIN 6- Pnnt or Type Name of Responsible O cer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in ad Agency Signature of Preparer(If different from responsible officer) PATRICIA C. MOORE, ATTORNEY LAIN 51020 Main Road Southold, NY 11971 D E C V LETTER 1�U (631) 765®4330 ` r� email: pcmoore@mooreattys.com JUL 1 7 2013 to To S i outhOld Town S bject Board f Trustee . . . . .. .. . . . .. . . . . . . . . . .. . . . . . . ... . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .... . SIGNED ❑ Please reply ElNo reply necessary BOARD OF TRUSTEES TOWN OF SOUTHOLD: NEW YORK ---------------------------------------------------------------x In the Matter of the Application of AFFIDAVIT OF NICHOLAS YUELYS MAILING Applicant's Land Identified as 1000-44-1-18 ---------------------------------------------------------------x COUNTY OF SUFFOLK) STATE OF NEW YORK) I, Betsy Perkins, residing at Mattituck, New York, being duly sworn, depose and say that: On the day of July, 2013 1 personally mailed at the United States Post Office in Southold, New York, by CERTIFIED MAIL, RETURN RECEIPT REQUESTED, a true copy of the attached Legal Notice in prepaid envelopes addressed to the neighbors on the attached list. Attached hereto is the white receipt post-marked by the Southold Post Office on said date. 7_7 _ B - t) � - etsy Perki '(Signature) Sworn to before me this 7-1Y da of July, 2013 (N ary Public M RGARET C. RUTKOWSKI Notary Public, State of New York No. 4982528 Qualified in Suffolk County Commission Expires June 3, PLEASE list, on the back of this Affidavit or on a sheet of paper, the lot numbers next to the owner names and addresses for which notices were mailed. Thank you. YUELYS NEIGHBOR LIST SCTM: 1000-44-1-19 HIRANT CANDAN 88-305 IST AVE ELMHURST NY 11373 SCTM: 1000-44-1-18 ALEXANDER& GAIL NORDEN 806 TOWNSEND ROAD N. MYRTLE BEACH SC 29582 SCTM: 1000-44-1-20 DOROTHYSNYDER 18 SKIPPS LANE BELL TERE NY 11777 SCTM: 1000-44-3-4.2 RECEIPT I RECEIPT RECEIPT I , 7104 2438 8090 0000 I 7104 2438 8090 0000 7104 2438 8090 00001690 1706 1713 j FROM: �, FROM FROM Moore Law Office I Moore Law Office j Moore Law Office RE YUELYS TRUSTEES RE YUELYS TRUSTEES RE YUELYS TRUSTEES I I I I � I � I I i I I SEND Tp I SEND TO- SEND To- ' ALEXANDER&GAIL NORDEN DOROTHY SNYDER 8-30 51 ! 18 SKIPPS LANE I 88 30 CANDAN � 806 TOWNSEND ROAD I 51ST NY N MYRTLE BEACH SC 29582 + BELL TERE NY 11777 ELMHURST NY 11373 i � I i FEES: i FEES FEES: Postagef Postage 046 Postage v I Ce; Bed ee 046-- I Certified Fee Certif Fee 0 46 FriR Ce 3 10 ' Return Receipt 3 10 Return Receipt 3 10 f +_eJ tl ip� 255 I Restricted 2 55 I TOT MY M Y 255 j i � TOTAL� 19� ,� v, / 17 j l '% O AL � I 11 I �,�� 1 OSTM D E ! i PO ARK P��� ARK OR�,p TE 0 BOARD OF TRUSTEES TOWN OF SOUTHOLD: NEW YORK ---------------------------------------------------------------x In the Matter of the Application of AFFIDAVIT OF SIGN NICHOLAS YUELYS POSTING Regarding Posting of Sign Upon Applicant's Land Identified as 1000-44-1-19 ---------------------------------------------------------------x COUNTY OF SUFFOLK) STATE OF NEW YORK) I, PATRICIA C. MOORE, residing at 370 Terry Lane, Southold, New York being duly sworn, depose and say that: On the day of July, 2013 1 personally posted the property known as 56005 County Road, 48, Southold, New York by placing the board of Trustees official Poster where it can easily be seen, and that I have checked to be sure the post has remained in place for eight (8) days prior to the date of the public hearing. Date of Hearing to be held on Wednesday, July 17, 2013, on or about 5:30 p.m. Sworn to before me this i L1, day of July, 2013 I�o�ary Pu is BETSY A.PERKINS Notary Public,State of New York No.01 PE6130636 Qualified in Suffolk Coun Commission Expires July 1M�- NOTICE OF - HEARING NOTICE IS HEREBY GIVEN that a public hearing will be held by the SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: A)1'cV)o10-5 Yue,11S SUBJECT OF PUBLIC HEARING: For the as-built 30.5'x26.2' cement block wall; reinforcement of existing damaged piles under dwelling; and for the existing single family 30.5'x26.2' dwelling with a 19.3'x9.5' landward extension and existing wood decks. TIME & DATE OF PUBLIC HEARING: C�@Ar , TV,11 17 aO 13 - 0_-�-or c&o u& S. . If you have an interest in this project, you are invited to view the Town file(s) which are available for ins ection rior to the day of the hearing during normal business days between the ours o 8 a.m and ,4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631 ) 765- 1892 Board of Trustees Application County of Suffolk State of New York NICHOLAS YUELYS BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION � r Sworn to before me this s day of �tl/'�i` , 2013 otary Pu 1 M7lfila V.VID Plobry Pylic,State of Kier Yc*! No.01Vt@24D614 UNMIi ion E*O Maki 2.2b1S i Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) Nicholas Yuelys as owners of premises 56005 County Road 48, Southold,New York, (sctm: 1000-44-1-19) residing at 3240 Tibbett Ave., Bronx,New York do hereby authorize my attorney, Patricia C. Moore,to apply for permit(s) and appear before the Southold Board of Town- Trustees on our behalf. �Oeesature) MARIA V.VIDAL •• ' Notary Public,State of New York, No.01 V16240574 OualiNd in Bronx County 60m*313 May 2.2b1s APPLICANT TRANSACTIONAL DISCLOSURE FORM (FOR SUBMISSION BY OWNER and OWNER'S AGENT) The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of Town officers and employees. The purpose of this form is to provide information,which can alert the Town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: YUELYS,NICHOLAS MOORE,PATRICIA (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company. If so,indicate the other person or company name.) NATURE OF APPLICATION:(Check all that apply.) Tax Grievance Variance Special Exception If"Other", name the activity: Change of Zone Approval of Plat Exemption from Plat or Official Map Other Trustees X Do you personally,(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. `Business interest" means a business, including a partnership, in which the Town officer or employee has even a partial ownership of(or employment by) a corporation in which the Town officer or employee owns more than 5% of the shares. YES NO_X Complete the balance of this form and date and sign below where indicated. Name of person employed by the Town of Southold: Title or position of that person: Describe that relationship between yourself(the applicant) and the Town officer or employee. Either check the appropriate line A through D(below)and/or describe the relationship in the space provided. The Town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant(when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this�day of /3 Signature. Nichola a ys �cia�C.M*e MAARIi0.V NIDAL N01ary Pubilo,State of New Yotla \ No.01VI6240574 CWftd 1n BWnX 00Unty, t anplNp�td�i Efgl M MO- 2,2015 y Town of Southold gErosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A 01 STORM-WATER,GRADING DRAINAGE AND EROSION CONTROL PLAN WssTcf- e-S cT oc CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? 1 Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within r 73© s• Generated by a Two(2")Inch Rainfall on Site? the Scope of Work for Proposed Construction) This item will Include all run-off created b site _ F]b. What is the Total Area of Land Clearing (S.F.r Acres) ( Y )( clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed 7 Site Improvements and the permanent creation of construction activity? (S.F.r Acres) Impervious surfaces.) 2 Does the Site Pian and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DFSCRIPTION (Provide Additional Pages as Needed) Drainage Structures Indicating Size&Location?This X Item shall include all Proposed Grade Changes and `y Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion fc> and sediment control practices that will be used to /_-` f control site erosion and storm water discharges. This 5�y y� C(amaq e: Item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards F] �L, 'L, of Material within any Parcel? /O�S O.L %1 VV�l 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand F X (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction x General DEC SWPPP Requirements: or within One Hundred(100')feet of a Wetland or Submission of a SWPPP Is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; Including disturbances of less than one acre that7 Will there be Site preparation on Existing Grade Slopes are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? — the DEC has determined that a SPDES permit is required for storm water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious ❑ for Storm Water Discharges from Construction activity-Permit No.GP-040-001.) Surfaces be Sloped to Direct Storm-Water Run-Off iC 1.The SWPPP shall be prepared prior to the submittal of the NOT.The Not shall be into and/or in the direction of a Town right-of-way? — submitted to the Department priorto the commencement of consWction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any ❑ constructed to reduce the pollutants In storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit.In addition,the SWPPP shall Area?(This Item will NOT Include the Installation of Driveway aprons.) identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. - NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the post-construction storm water management practice in a Box and the construction site disturbance Is between 5,000 S.F.&1 Acre in area, component shall be prepared by a qualified Design Professional Licensed in New York a Storm Water,Grading,Drainage&Erosion Control Plan Is Required by the Town of that is knowledgeable in the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit (NOTE: A Check Mark(,I)and/or Answer for each Question Is Required for a Complete Application) STATE OF NEW YORK, ff COUNTY OF.....� .jd .............SS That I,.......Cts �. u••••l.-••• �� ..........being duly sworn,deposes and says that he/she is the applicant for Permit, (Name of individual signing Document) And that he/she is the .................................... ... .Owner,Coritra. .Agent,Corporate Officer,etc.)............................................................... Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his knowledge and belief;and that the•work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; � .. .��...�..........ZG t..............day of.. .. ..........�. lr131i.t11�'!8�.dol New York Notary Public: .....................Hata public'.St�1 .........4................. ............................................................. o:48327 (Signature of Applicant) FORM - 06/10 rata I ° all y--_ � '�990 commission JaaausrY . YUELYS 56005 CTY ROAD 48, SOUTHOLD SCTM: 1000-44-1-19 PROJECT DESCRIPTION: Aa� .Io�tA Rtplttee 30.5 x 26.2 feet cement block wall; reinforcement of existing piles damaged by Super Storm Sandy and pre-existing single family dwelling. ��_ G X 2(v•Z w��Pn tnroc d cel am d ► s•3f x g•5 P�x�eyt sc�� Town of Southold f LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS i 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. i I 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list,policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significants beneficial and adverse effects upon the coastal area(which includes all of Southold Town) i 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- j supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. i A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net),the Board of Trustees Office,the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION D ; i' SCTM# 44-1-19 _ _ UUN 2 0 2013 ! i' PROJECT NAME foundation repair/replacement Board of Trustees The Application has been submitted to(check appropriate response): i. Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 0 1. Category of Town of Southold agency action(check appropriate"response): (a) Action undertaken directly by Town agency(e.g.capital construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: Nature and extent of action: repair existing foundation under house, replace footings and cement wall damaged by YUELYS 56005 CTY ROAD 48, SOUTHOLD SCTM: 1000-44-1-19 PROJECT DESCRIPTION: A '5 x 26.2 feet cement block wall; reinforcement of existing piles damaged by Super Storm Sandy and pre-existing single family dwelling. wc:-k �l16�z1 cede c71vo 1 3 +, x M Location of action: 56005 County Road 48 Site acreage: 4.730 sf j Present land use: existing dwelling Present zoning classification: r-40 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: Nicholas Yuelys (b) Mailing address: 3240 Tibbett Avenue Bronx NY !I (c) Telephone number:Area Code( ) (d) Application number,if any: I Will the action be directly undertaken,require funding,or approval by a state or federal agency? i Yes ❑ Nom If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space,makes efficient use of infrastructure,makes beneficial use of a coastal Iocation, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. XJ Yes ❑ No [:] Not Applicable existing house preexisting nonconforming-foundation damage during SANDY storm-immediate ac ion require Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No El Not Applicable i Attach additional sheets if necessary i Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria �. { ❑ Yes ❑ No Q Not Applicable i' , +1 i Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures and natural resources from flooding and erosion. See LWRP i Section III—Policies Pages S through 16 for evaluation criteria } i ❑x Yes ❑ No ❑ Not Applicable i existing house damaged by storm-foundation repairs required protect existing stnacturre j I , Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes E] No 0 Not Applicable i I Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Applicable ' 1 I k 1 1 f 1 I Attach additional sheets if necessary I f Policy 7. Protect -and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. Yes No Not Applicable f' i i Attach additional sheets if necessary I I Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous i substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ Na W Not Applicable i I PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public � resources of the Town of Southold. See LWRP Section III—Policies;Pages 38 through 46 for evaluation criteria. ❑ Yeo No® Not Applicable Attach additional sheets if necessary i WORIUNG COAST POLICIES j Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies;Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ NoX❑ Not Applicable ; I ; Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic j3 Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No❑ Not Applicable ` s i Attach additional sheets if necessary I Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III —Policies; Pages 62 through 65 for evaluation criteria. ! ❑ Yes ❑ No❑X. Not Applicable ' I Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP ` Section III--Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No N Not Applicable 1 PREPARED 13Y Patricia C. Moore TITLE AGENT DATE 6/18/13